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Two Saints Jon Cox on a new approach

4 October 2011

"A key factor in improving outcomes for people with Complex trauma (or personality disorder) is the response they receive from staff."

The Psychologically Informed Environment is one which 'seeks to understand people's reactions to, and ways of coping with traumatic experiences'. The Department for Communities and Local Government and the National Mental Health Development Unit commissioned some research, pilots and ultimately a good practice guide in May 2010 (from which I quote throughout this update).

The research suggests that 'Adopting a more psychologically skilled approach will help to provide more positive outcomes for clients; particularly for those who may have learnt ineffective and destructive coping strategies which affect their ability to maintain relationships or accommodation' ; furthermore 'Accommodation on its own, even coupled with support, will very rarely enable people experiencing complex trauma to deal with negative self-belief or emotional disregulation and change how they behave.' In short 'Without addressing the trauma it can be difficult to support people to stabilise their lives and find and keep accommodation and also maintain relationship's and engage in positive meaningful activities'.

The report also suggests some clients 'may behave and think in particular ways which perpetuate their problems. This makes key working very hard and at times frustrating for both client and worker' but firmly asserts 'A key factor in improving outcomes for people with Complex trauma (or personality disorder) is the response they receive from staff.'

Importantly it recognises support workers role and contribution going on to say 'The high prevalence of personality disorder and complex trauma among clients of some homelessness services means that hostel staff and resettlement workers can often find themselves engaged in quite psychologically sophisticated and demanding work, for which they should be properly recognised, trained and supported. It is important for staff and commissioners to understand that this approach complements but does not replace access to mainstream clinical psychology services by clients.'

I am sure that many of you will recognise this as the simple truth as I do. We can also see that by becoming more psychologically aware in our practices we will benefit ourselves as staff and all clients, not just those with Complex Trauma (estimated at 60% in hostels). The Psychologically Informed Environment is an approach and not a place.

So how do we embed this new approach?

Service and Senior Managers met on 21st September and formulated an Action plan to move us forward.

This focussed actions on five key areas:

Practice – Embedding reflective and other practices into the fabric of what we do. The report suggests 'It is the changes in day-to-day running, derived from reflective practice and discussion, that mark the development of the PIE. Reflective practice is an essential component of effective, safe work with people who suffer complex trauma.' This will afford staff much more forum to gain management and peer support for the work they do.

Policy and Procedure – looking at how we need to review our P & P's to embrace the PIE approach.

Staff Training – how do we ensure our staff have appropriate training , supervision and support in this area?. We also need to understand the boundaries and keep all safe and clear about where support workers role ends and that of professional services begins.

Physical (Buildings) – how we maintain, select, design and modify our buildings as the opportunity comes along to create the best physical environment possible to engender engagement and positive outcomes.

Communication - How do we communicate this approach and the changes it entails to staff, clients and stakeholders?

The last thing to say is that this is not another thing to do, far from it, is the obvious bedfellow to our other advancements with respect to personalisation and person centred planning and is simply a different, not additional, way of doing things. We are confident this approach will give staff more support, training and forum to enhance the already exemplary job that they do. 

Jon Cox, Head of Business Development. 

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